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The Role of Retail in Revolutionizing Health Care, Part V

In this fifth of a six-part series, Dave Nazaruk, senior vice president, retail business development for StayWell/MediMedia USA, a leading provider of patient education and consumer health information, continues his exploration of the role of retail in revolutionizing health care and the economy.

September 28, 2009, 08:00 pm
By Dave Nazaruk

Previous articles in this series on the retail industry’s impact on the health care system examined three consumer Touch Points that position food and drug retailers as unique in the health care delivery system to transform how we think about health and wellness, to dramatically improve the health of our fellow citizens, and to revitalize the U.S. economy in the process. Those Touch Points are:

Leveraging Retail’s Influence It is these three highly compelling and overlooked factors that retailers, more than any other segment of the health care delivery system, have the greatest influence over in engaging consumers to adopt healthier lifestyles. Indeed, food and drug retailers are uniquely positioned to:• Spark a major revolution in consumer health and wellness.• Become consumers’ first choice for information, products and services to improve their health, increasing sales of those products and services.• Capture a large share of online advertising revenues for products currently being absconded by eHealth sites, by providing manufacturers with highly targeted shopper populations.• Greatly enhance Rx, OTC, CPG and other health-related product sales.

Models of Engagement: Critical Consumer Health Issues Where Retail Can Have Enormous Impact Consider just two examples of how retailer-based population health management programs could contribute significant savings to consumers and employers, increase productivity, enhance health outcomes to a wide number of participants, and help recover our faltering economy:

Overweight/Obesity Issue Overweight and obese adults pose a grave economic threat in regard to illness, disease and lost productivity. This problem costs the nation $61 billion annually in medical services, medications and products to treat the diseases inherent to being overweight and obese. It costs $56 billion annually in productivity lost to illness or death. Direct contributors to the obesity problem include a sedentary lifestyle and recreational and addictive eating.

The problem of obesity is a multidimensional one, requiring an interdisciplinary approach. Consumers must take responsibility, but the outcomes can be expected to be more successful if taking responsibility for healthier choices is encouraged and rewarded. Encouragement can come from manufacturers, the government and retail.

Retailers are in a unique position to deliver nutrition/weight management programs that are both turnkey and highly personalized for their shoppers, and that can track and reward participation — making such programs ideal new vehicles for targeted marketing opportunities for manufacturer partners. Components of a sample program could include but not be limited to the following:

Medication Adherence Issue Research also shows that medication adherence is by far the most cost-effective way to produce the greatest health benefits in patients with high-cost chronic conditions. Strict adherence to a doctor-prescribed medication regimen produces the best outcomes and decreases the number of emergency room visits, and other adverse and even catastrophic events (heart attacks, strokes, acute respiratory distress, etc.). Yet, study after study shows that the “decay curve” for many so-called maintenance drugs — that is, the point at which patients typically “fall off” therapy (stop taking the drug or begin a pattern of very sporadic dosing) — frequently begins after the first month and quickly bottoms out by month three, producing significantly negative outcomes for everyone with a stake in that patient’s health:

• For the patient, the cost can be as minimal as a lost day or two of work up to a catastrophic event possibly leading to disability, long-term impairment or even death.• For the provider, the result could be diminished health grade scoring and the financial impact on reimbursements.• For the employer, lost productivity coupled with the looming specter of year-on-year double-digit increases in employee health benefits is crippling both financially as well as psychologically.• For the drug’s manufacturer, the cost in lost sales is just as dramatic, particularly in this day of shrinking pipelines and few approved next-generation blockbusters on the horizon.• For retail pharmacy, the lost dispensing fees on the number of prescriptions that figure represents is a staggering amount. (According to the Food Marketing Institute’s “2008 Food Retailing Technology Benchmarks” study, the average MTM client, for example, uses 8.5 maintenance medications and spends $4,000 annually on those medications, and non-adherence is a critical issue with this particular population.) If this revenue loss is remedied, it could lift the dwindling fortunes of retail pharmacy.

For the U.S. economy, the following statement from the “2008 Pharmacy Principles for Health Care Reform” illustrates how critical finding this adherence fix is:“Our nation’s pharmacists play a critical role in providing affordable, accessible and quality health care. Proper use of prescription medications helps improve quality of life and health outcomes. However, the health care system incurs more than $177 billion annually in mostly avoidable health care costs to treat adverse events from inappropriate medication use. The proper use of medication becomes even more important as treatment of chronic disease costs the heath care system $1.3 trillion annually, or about 75 cents of every health care dollar.”

Costly medication-related problems (MRPs) occur when proper use of prescription medications does not happen. MRPs rival the costs of cardiovascular disease and are more than the direct health care costs of diabetes and Alzheimer’s disease combined. For every dollar spent on prescription medications, we spend approximately the same amount treating MRPs associated with those medications.

Reasons for this lack of better medication adherence range from mild to serious side effects to financial considerations (decisions especially among the elderly to forgo either food or expensive drugs) to confusing or lax prescriber instructions about the critical importance of staying on one’s drug regimen, to lack of follow-through — by manufacturers and retailers — at the point of dispensing: in stores themselves and especially right at the pharmacy counter. While the first factor presents a challenge not easily addressed in this article, the latter two factors are eminently fixable via pharmacist counseling at the highest touch to education, awareness and reminder programs at the most turnkey — all of which can be delivered at scale via electronic means (online, e-mail, text, IVR) to registered users.

Part VI of this series will examine funding options for creating a broad-based population health management solution through the retail sector and also issue a call to action to the industry to provide more vigorous leadership in the current health care reform debate. To download a comprehensive White Paper on this topic from Nazaruk, visit Get Role of Retail in Revolutionizing Health Care White Paper.